“Shared joy, twice joy-Shared sorrow, half sorrow”
The morning I got the results of yet another PSA that was creeping up, I stopped one of my partners outside of an exam room and asked him if he would do a biopsy of my prostate at lunch. He agreed, and I told him I’d have my nurse come get him when I was ready. When the morning patients had been seen, I asked my nurse to set up the stuff for a biopsy, and within an hour of deciding to have my prostate biopsied, I find myself in the biopsy room. I pull down my scrubs, get on the table on my left side, assume the fetal position required for the procedure, and tell Tina, “go get Dr. Jones; I’m ready.” In one fell swoop I am exposing my naked backside to my nurse and my partner, and, in doing so beginning my journey as a patient. I had had many patients tell me over the years, “I was modest before I became a urology patient,” and now I was getting my “education.”
I did take an antibiotic to prevent infection, but I did not take anything for pain. My plan was to have the biopsy, go get lunch, and then come back to see my afternoon patients. Dr. Jones obligingly enters the procedure room to perform the biopsy I have requested just minutes before. “What is your PSA, John?” “Five or so. Will you check my prostate before you begin?” “Sure,” he says, “It feels normal.” He places the ultrasound probe in the rectal area, and there is an abrupt and intense sensation of needing to void. (Pressure on the prostate by the rigid probe irritates the prostatic urethra. The resultant sensation of needing to void is similar to that experienced by patients after radiation.) He then injects an anesthetic into the prostate to deaden the effect of the biopsies but tells me, “I don’t see the seminal vesicles very well.” What this means is that the medicine he is injecting may not control the pain of the biopsy. That’s a luck thing; my anatomy probably didn’t lend itself to a good nerve block. However, altered anatomy can also mean changes as a result of cancer, and my mind immediately went wild, wondering, why my seminal vesicles were difficult to see. He began the process of taking the specimens with a biopsy gun that fires a biopsy needle that, in turn, captures the prostate tissue. You hear a click when it fires and then feel a pain that is similar to a bee sting, but a bee sting that is accompanied by an intense burning at the tip of your “you know what.” It felt to me as if someone was popping a rubber band at the tip of my “private area” with each biopsy; he did 16. Somewhere in the middle of this ordeal, as I was debating the wisdom of doing this at lunch without the benefit of pain medicine, Dr. Jones says, “John, shared joy-twice joy, shared sorrow-half sorrow.” After these obtuse words of wisdom, which I failed to grasp, came another “pop.” I propped up on my elbow and looked back at Dr. Jones over my shoulder. “Twice grief, shared what? What in the world is that supposed to mean, Bill?” Tina says quickly, “He says that to everybody having a biopsy.” “Well John, you should share things with people. Don’t keep things to yourself; it is better to discuss your problems with friends.” Tina added, “Dr. McHugh only has one friend, Dr. Tolson.” I said, “What do you mean, share with my friends? Share what? I don’t have cancer yet. You just got started! Do you see something back there that you don’t like?” “No, not really anything bad, just an area that doesn’t look right. I’ll take just a few more in that area and we’ll be done.” The biopsies just kept on coming; a click, a pop, the bee sting, the rubber band, and the incessant feeling of needing to urinate. This adventure into being a patient ended after about 20 minutes. I got up, thanked Bill, and then went into the bathroom dripping blood from the front and back. That afternoon, I had to inform two people that their biopsies for prostate cancer were positive, all the while concerned that blood would show through the front of my scrubs. The next phase of my journey as a patient then began: waiting on the results and wondering if I had cancer at all, if I had the good kind, or if I could be the one with the “tiger” variety, (which is how the British describe the aggressive form of prostate cancer). Again, the dual nature of the disease is something that patients often don’t realize.